States Reignite Abortion Debate

By

Anna Wilde Mathews

Updated April 8, 2010 12:01 a.m. ET

Less than three weeks after the passage of the landmark national health-care bill, the abortion debate is being reignited: Lawmakers in least six states are pushing for legislation to block abortion coverage in some health plans.

After rancorous clashes over abortion coverage in the national bill, opponents were assured that federal funds wouldn't subsidize coverage of the procedure.

ENLARGE

An anti-abortion demonstrator, right, tries to cover a sign of an abortion-rights activist, left, during a demonstration in front of the Supreme Court in Washington on Jan. 22.
Associated Press

The final legislation requires insurers that sell plans in new government-run exchanges to segregate payments for abortion coverage from other premiums to ensure government subsidies won't go toward the procedure.

Still, many abortion opponents say that didn't go far enough.

So lawmakers are turning to another provision in the legislation that says states can choose to prevent plans offered through their exchanges from covering abortion altogether. That would likely affect most individual and small-group plans in a state, starting when the exchanges launch in 2014.

The new state-level proposals are likely to rekindle abortion as a political issue in November elections. Many state candidates, particularly those running for governor and state legislature, may be forced to take a position on abortion coverage, said John C. Green, director of the Ray C. Bliss Institute of Applied Politics at the University of Akron. "Once an issue like this starts being debated in a state, everyone could become involved," said Mr. Green, who studies how religion affects elections.

The debate could spill over to congressional races as well. But these are expected to largely turn on bigger-picture issues like the economy and the role of government, said Charlie Cook, who edits the Cook Political Report.

Since the beginning of this year, lawmakers in five states including Tennessee and Oklahoma have introduced bills that would generally block abortion coverage in exchange plans, according to the Guttmacher Institute, a research group that supports abortion rights.

Health-Care Overhaul Prompts State Action

Percentage of uninsured women ages 15–44 likely to qualify for insurance-exchange subsidies. Click to see graphic.

In Mississippi, state Sen. Alan Nunnelee, who is a Republican candidate for Congress, plans to introduce a similar bill this month. The federal language in the health bill, Mr. Nunnelee said, is "absolutely not" enough to ensure that government funds don't support abortion. Mr. Nunnelee is in a competitive congressional race this fall, according to the Cook Political Report.

Missouri state Sen. Scott Rupp, a Republican, is also backing such a bill. The state law already says that private plans generally won't cover abortion, except through special riders, but "we had to move over the ban to the exchanges," he says.

At least one state, Kansas, has seen a bill introduced this year that would prohibit insurance plans generally—not just in an exchange—from covering abortion, with certain exceptions. Five states, including Missouri, have similar laws, which don't affect large self-funded employer plans that aren't overseen by state regulators.

Lawmakers in at least three other states have introduced bills to ban abortion coverage in plans for state employees. Twelve states currently have such laws, according to Guttmacher.

"The federal debate has brought it to attention," said state Sen. Linda Gray of Arizona. Ms. Gray, a Republican, introduced a bill that she said would formally block localities in Arizona, which get part of their budget from state funds, from covering most abortions for their employees.

Both abortion opponents and groups favoring abortion rights say they expect to see a growing number of state-level fights over the issues raised by the federal law.

It's not clear how much state restrictions on abortion coverage in their exchanges would affect abortion access. Different studies have found different levels of coverage for abortion among private plans. One from Guttmacher said that 13% of abortions in 2001 were directly billed to insurers, though the institute says this may not give a full picture, since covered women may pay up front and seek reimbursement. Many women seeking abortion are uninsured or have Medicaid, which generally doesn't cover abortion.

If states restrict abortion coverage in the exchanges, "certainly, some will have to pay out of pocket who would have had coverage before," though it's hard to project exactly how many, said Cynthia Pearson, executive director of the National Women's Health Network, which favors abortion access. The average amount paid for an abortion at 10 weeks, the point by which the vast majority of abortions in the U.S. are performed, was $413 in 2006, according to Guttmacher. But it can cost far more for women who are seeking abortions later in their pregnancies because of medical complications, Ms. Pearson said.

America's Health Insurance Plans, a lobbying group, believes "it's up to policy makers to decide," said Robert Zirkelbach, a spokesman. A spokeswoman for insurer WellPoint Inc. said it abides by state abortion-coverage regulations and will continue to do so.

Overall, the number of abortions in the U.S. was an estimated 1.2 million in 2005, the most recent year available from Guttmacher, some 8% fewer than 2000. In 2005, there were 1,787 abortion providers, 2% fewer than five years before, and some 87% of U.S. counties didn't have an abortion provider. The number of providers has generally dropped over the years, because of factors including medical schools not always teaching the procedure and concerns about protests and violence, according to Guttmacher.

Vicki Saporta, president of the National Abortion Federation, an abortion-provider group, said she believes the number of clinics offering surgical abortions has remained fairly steady since 2005. Abortions due to medication, or the drug mifepristone, once called RU-486, are now more accessible than they were five years ago because a growing number of family-planning clinics offer them, she said.

Many of the new bills may fail to become law this year. But those that don't pass are likely to resurface next year.

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